Hindawi Canadian Respiratory Journal Volume 2019, Article ID 4897045, 2 pages https://doi.org/10.1155/2019/4897045 Letter to the Editor Response to: Comment on “Noninvasive Ventilation Weaning in Acute Hypercapnic Respiratory Failure due to COPD Exacerbation: A Real-Life Observational Study” Paola Faverio ,1 Anna Stainer,1 Federica De Giacomi,1 Grazia Messinesi,1 Valentina Paolini,1 Anna Monzani,1 Paolo Sioli,1 Irdi Memaj,1 Oriol Sibila,2 Paolo Mazzola,3 and Alberto Pesci1 1 School of Medicine and Surgery, University of Milan Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy 2 Respiratory Department, Hospital de La Santa Creu I Sant Pau, Autonomous University of Barcelona and Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain 3 School of Medicine and Surgery, University of Milan Bicocca, Acute Geriatrics Unit, San Gerardo Hospital, ASST Monza, Monza, Italy Correspondence should be addressed to Paola Faverio; paola.faverio@gmail.com Received 16 July 2019; Accepted 25 July 2019; Published 8 October 2019 Academic Editor: Pierachille Santus Copyright © 2019 Paola Faverio et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We thank Karim and Esquinas [1] for their interesting requiring NIV in the prior year and/or comorbidities such as comments. obstructive sleep apnea or obesity-hypoventilation syn- Our study aimed to report a real-life experience and the drome. When considering the parameters used during personalized approach we used in the weaning phase [2]. ventilation, no difference was found between the inspiratory We do agree with Karim and Esquinas that this approach positive airway pressure (IPAP) and expiratory positive with the number of days at each stage of weaning at airway pressure (EPAP) used in the acute and chronic phase. physician discretion limits the generalizability of the From a clinical point of view, in some cases, both IPAP and results. EPAP were reduced 1 to 2 cmH2O from the acute to the It is worth noticing, however, that most patients that chronic setting. completed weaning stayed at each stage the minimum time In regard to the risk of pneumothorax in patients with required by the protocol (1 day). The maximum time they severe bullous emphysema, in our cohort, we only had one spent in each weaning phase was 2 days. These data suggest case out of 51 patients in whom NIV weaning was attempted; that, although patients’ evaluation and final decision is based therefore, any further speculation is impossible. We think on physicians’ clinical judgment, having objective criteria that, given the controversy of the subject, the need to and a weaning protocol to follow allows standardization of prolong NIV application after the acute phase should be the treatment in most cases. evaluated on a case-by-case basis and the risk of pneumo- Regarding the 20 patients adapted to domiciliary non- thorax vs. the benefit of the prevention of AHRF recurrence invasive ventilation (NIV), the acute phase, meaning re- must be carefully considered. spiratory acidosis with respiratory distress, was solved in all We agree with Karim and Esquinas that future studies cases. We prescribed domiciliary NIV in those COPD pa- are needed in order to better identify which subgroups of tients with persistent daytime hypercapnia after at least two COPD patients with AHRF might benefit the most from the episodes of acute hypercapnic respiratory failure (AHRF) weaning process. 2 Canadian Respiratory Journal Conflicts of Interest The authors declare that they have no conflicts of interest. References [1] H. M. R. Karim and A. M. Esquinas, “Comment on “Non- invasive ventilation weaning in acute hypercapnic respiratory failure due to COPD exacerbation: a real-life observational study”,” Canadian Respiratory Journal, vol. 2019, Article ID 5490510, p. 2, 2019. [2] P. Faverio, A. Stainer, F. De Giacomi et al., “Noninvasive ventilation weaning in acute hypercapnic respiratory failure due to COPD exacerbation: a real-life observational study,” Canadian Respiratory Journal, vol. 2019, Article ID 3478968, p. 10, 2019.